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cardiovascular med surg 2 > ch 22 > Flashcards

ch 22 Flashcards

1
Q

conduction - Send A Big Bounding Pulse

A
  1. SA node
  2. AV Node
  3. Bundle of His
  4. R/L Bundle Branches (right and left)
  5. Purkinje Fibers

depolarization: - to + contraction

Re-polarization + to - relaxation

cardiac conduction system generates and transmits electrical impulses which stimulates contraction of the atria and then the ventricles

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2
Q

SA Node (SinoAtrial node)

A

“automaticity”

primary pace maker of the heart

creates electrical impulse of 60-100 BPM (normal heart rate)

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3
Q

AV Node (AtrioVentricular)

A

secondary pacemaker of the heart (backup pacemaker)

if SA node malfunctions, the AV node takes over

40-60 BPM

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4
Q

purkinje fibers

A

if SA and AV nodes fail the purkinje fibers can fire at a rate of 30-40 BPM

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5
Q

P Wave

A

reflects conduction of an electrical impulse through the atrium

represent atrial depolarization

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6
Q

QRS Complex

A

reflects conduction of an electrical impulse through the ventricles

represent the ventricles depolarization

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7
Q

T Wave

A

reflects repolarization of the ventricles

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8
Q

PR Segment

A

flat line between the end of P-wave and the start of QRS Complex

reflects the delay between atrial and ventricular activation

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9
Q

ST Segment

A

reflects the end of QRS Complex to the beginning of the T wave

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10
Q

PR Interval

A

reflects the conduction of an electrical impulse from the sinoatrial node (SA) through the atrioventricular node (AV)

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11
Q

QT interval

A

reflects the time from ventricular depolarization through repolarization

measured from beginning of QRS complex to the end of the T wave

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12
Q

RR Interval

A

the duration between the beginning of one QRS complex and the beginning of the next QRS complex

used to calculate ventricular rate and rhythm

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13
Q

PP Interval

A

the duration between the beginning of one P wave and the beginning of the next P wave

used to calculate atrial rate and rhythm

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14
Q

U Wave

A

reflect the purkinje fibers repolarization

not seen unless patient is hypokalemic (low Potassium)

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15
Q

Basic rhythms

A

normal sinus: 60-100 bpm

sinus tachycardia: > 100 bpm

sinus bradycardia: < 60 bpm

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16
Q

ekg interpretation: P wave

A

should be present and upright

comes before QRS complex

one P-wave for every QRS Complex

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17
Q

EKG interpretation: PR Interval

A

measure PR interval

normal: 0.12 - 0.2 seconds

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18
Q

EKG Interpretation: QRS Complex

A

is every P wave followed by a QRS complex?

should not be widened or shortened - may indicate problems

widened is often seen in PVCs, electrolyte imbalances, and drug toxicity

normal: 0.06 - 0.12 seconds

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19
Q

EKG Interpretation: RR interval

A

are the RR intervals consistent?

regular or irregular

20
Q

ekg boxes

A

1 large box = 0.20 seconds

5 large boxes = 1 second

1 small box: 0.04 seconds

21
Q

normal sinus rhythm

A

rate: 60-100 bpm

P waves: present, consistent configuration, one p wave before each QRS complex

PR interval: 0.12 - 0.20 seconds and constant

QRS duration: 0.06 - 0.12 seconds and constant

22
Q

EKG interpretation: determine heart rate 6 SECOND METHOD

A

count the number of Rs in between the 6 second strips and multiply by 10 ( be sure to check that the strip is 6 seconds by counting the boxes)

6 Rs X 10 = 60 beets per minute

23
Q

EKG interpretation: determine heart rate BIG BOX METHOD

A

300 divided by teh number of big boxes between 2 Rs

300/5 = 60 Bpm

24
Q

electrocardiography

A

12 - lead ECG

continuous monitoring

25
Q

hardwire

A

A cardiac monitor at the patient’s bedside for continuous reading; this kind of monitoring, usually called hardwire monitoring, is used in intensive care units

26
Q

Telemetry

A

A small box that the patient carries and that continuously transmits the ECG information by radio waves to a central monitor located elsewhere

27
Q

ambulatory monitoring

A

A small, lightweight tape recorder–like machine (called continuous ECG monitoring, which might include a Holter monitor or a patch monitor) that the patient wears for a prescribed period and that continuously records the ECG, which is later viewed and analyzed with a scanner

28
Q

intermittent monitoring using a looped recorder

A

A very small device inserted under the skin or worn externally on a wrist band that can perform ECG monitoring on demand whenever a patient is symptomatic

29
Q

EKG indications for dysrhythmias

A

sinus bradycardia/tachycardia

AV blocks

atrial fibrillation

ventricular asystole

premature atrial complexes (PACs) and premature ventricular complexes (PVCs)

supraventricular tachycardia

ventricular tachycardia

ventricular fibrillation

30
Q

client presentation for dysrhythmias

A

cardiovascular disease

myocardial infarction (MI)

hypoxia

acid-base imbalances

electrolyte disturbances

31
Q

Preprocedure nursing actions cardio

A
  1. prepare client for 12-lead ECG if prescribed
  2. position client in supine with chest exposed
  3. wash client’s skin to remove oils
  4. if the area on which electrode is placed has hair CLIP DO NOT SHAVE area to provide skin adherence and electrical conduction
  5. attach one electrode to each of the client’s extremities by applying electrodes to flat surfaces above the wrists and ankles and the other six electrodes to the chest, avoiding chest hair
32
Q

intraprocedure nursing actions cardio

A

monitor for manifestation of dysrhythmias (chest pain, decreased LOC, shortness of breath, hypoxia)

client education: remain still and breathe normally while the 12-lead ECG is performed

33
Q

post-procedure nursing actions cardio

A
  1. remove leads from the client
  2. print ECG report
  3. notify provider
  4. apply a holter monitor if the client is on a telemetry unit and/or needs continuous cardiac monitoring
  5. continue to monitor the client for dysrhythmia
34
Q

sinus node arrhythmias

A

originate in the SA node

-sinus bradycardia
-sinus tachycardia
-sinus arrhythmia

35
Q

atrial arrhythmias

A

-atrial flutter
-atrial fibrillation
-supraventricular tachycardia
-premature atrial complex

36
Q

ventricular arrhythmias

A

-premature ventricular complex
-ventricular tachycardia
-ventricular fibrillation
-ventricular asystole

37
Q

conduction abnormalities

A

-first degree atrioventricular block
-second degree atrioventricular block, type 1 (Wenckeback)
-Second-Degree Atrioventricular Block, Type 2
-third-Degree Atrioventricular Block

38
Q

sinus bradycardia - CAUSES

A

-can be normal for some people (athletes who have baseline bradycardic rate)
-damage to the heart d/t heart disease
-vagal stimulation
-hypothermia, hypoglycemia
-hypothyroidism
-certain drugs or medications (cholinergics, adrenergic blockers, opioids)

39
Q

sinus bradycardia - SIGNS AND SYMPTOMS

A

-slow pulse rate
-near fainting or fainting (syncope)
-fatigue, dizziness, lightheadedness
-shortness of breath
-chest pain
-confusion or trouble with memory
-easily tired during physical activity

40
Q

sinus tachycardia - CAUSES

A

-exercise
-hypertension
-emotional distress, anxiety, fear
-damage to the heart d/t heart disease
-electrolyte imbalance
-hyperthyroidism
-severe bleeding/shock/hypovolemia (low blood plasma level)
-certain stimulants or medications (anticholinergics/adrenergics, caffeine, nicotine)

41
Q

sinus tachycardia - SIGNS AND SYMPTOMS

A

-rapid pulse rate
-sensation of rapid heartbeat (palpitations)
-shortness of breath
-dizziness, fainting (syncope), anxiety
-chest pain
-trouble exercising
-headaches

42
Q

treatment - arrhythmias

A

-maintain airway, supplemental oxygen, obtain IV access, monitor EKG
-in unstable patient will have altered LOC, ischemia (reduced blood flow), shock, decreased BP
-synchronized cardioversion
-if QRS wide: >0.12 sec
-carotid massage (vagal stimulation)

43
Q

antiarrhythmic medications

A

-adenosine
-amiodarone
-Beta blocker (-olol)
-procainamide

44
Q

premature atrial contractions

A

early extra beats that originate in the atria (upper chambers of the heart). PAC are harmless and do not require treatment

45
Q

atrial fibrillation

A

very common irregular hearth rhythm that causes the atria to contract abnormally

46
Q

supraventricular tachycardia

A

common dysrhythmia that occurs when an impulse is conducted to an area in the AV node that causes the impulse to be rerouted back into the same area over and over again at a very fast rate. each time the impulse is conducted through this area, it is also conducted down into the ventricles, causing a fast ventricular rate

47
Q

atrial flutter

A

similar to atrial fibrillation but has a more regular pattern

cardiovascular med surg 2 (1 decks)

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